Individual provider Active NPI

Stanislav Avshalumov, DO

  • Orthopaedic Surgery Physician
  • Valley Stream, NY
National Provider Identifier
1730108291
Registry record updated May 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
233630 Issued in NY
Practice address
133 E Merrick Rd
Valley Stream, NY 11580-5900
Phone
(516) 887-5500
Fax
(516) 887-5509
NPI assigned
Jul 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 233630 NY Primary

Addresses

Primary practice location

133 E Merrick Rd
Valley Stream, NY 11580-5900

Mailing address

133 E Merrick Rd
Valley Stream, NY 11580-5900
Phone (516) 887-5500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090422000297 NY Practitioner - Orthopedic Surgery 4688747728 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
New York College of Osteo Medicine of New York Institute of Technology, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Orthopedics and Joint Preservation PCGroup PAC ID 6103077961, 4 clinicians

Practice addresses (Care Compare)

133 E Merrick Rd
Valley Stream, NY 11580-5900
Phone (516) 887-5500

Hospital & facility affiliations

  • Mount Sinai South Nassau Hospital, Oceanside, NY, CCN 330198

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10
Knee replacement1-10
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
233630NYMDLicensed Practical Nurse

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746748800000",
    "number": "1730108291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 E MERRICK RD",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115805900",
            "telephone_number": "516-887-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 E MERRICK RD",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115805900",
            "telephone_number": "516-887-5500",
            "fax_number": "516-887-5509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVSHALUMOV",
        "first_name": "STANISLAV",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2025-05-09",
        "certification_date": "2025-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NY",
            "license": "233630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valley Stream, NY

Sources for this page

Verify at the official NPI Registry.